The Shocking Truth About Antibiotic Resistance

What is Antibiotic Resistance?

Antibiotic resistance is the ability of bacteria to withstand the antimicrobial power of antibiotics. Simply put, antibiotics that used to cure an infection no longer work; they cannot effectively kill the bacteria, their growth is not stopped, and the infection is either not cured or reoccurs.

All types of micro-organisms, including bacteria, viruses, fungi, and parasites have the ability to develop resistance to medications. Infections with resistant organisms are difficult to treat, and other options -- when available -- are often very costly and may be linked with greater side effects.

Antibiotic resistance is a global threat, and The US Centers for Disease Control and Prevention (CDC) considers antibiotic resistance one of their top health concerns. Infections with drug-resistant bacteria may lead to longer hospital stays, more costly care, and an increased risk of death.

What Are Antibiotic Resistant Bacteria?

Antibiotic resistant bacteria are exactly what they sound like -- the bacteria cannot be fully inhibited or killed by an antibiotic. The drug may have been able to cure an infection in the past before the resistance occurred, but now it is not effective.

How does this happen? Bacteria become resistant to antibiotics by adapting their structure or function in some way that prevents them from being killed by the antibiotic.

Examples of bacteria that have become antibiotic resistant include those that cause:

New tests are being developed that can more quickly identify resistant bacteria in the lab. In fact, a new test was FDA-approved to look for genetic markers associated with drug-resistant bacteria, specifically for the drug class known as carbapenems, which are powerful antibiotics used for severe infections, like:

Why is Antibiotic Resistance So Important?

Antibiotic resistance can lead to a life-threatening bacterial infection. One reason bacteria are becoming resistant is because antibiotics are sometimes inappropriately used for an illness caused by a virus. An antibiotic cannot cure a viral infection.

Frequently the antibiotic prescriptions written for patients are not optimal, according to the CDC. Drugs may be prescribed when no antibiotic is needed, there may be an incorrect dose, or the length of treatment is wrong. All of this can contribute to antibiotic resistance.

Talk to your doctor about your illness, discuss whether it is a bacterial or viral illness, and ask if you really need an antibiotic. Antibiotics are often linked with side effects -- like rash or diarrhea -- you might prefer to avoid, if possible. You can treat most viral illnesses with simple treatments to ease your symptoms, and, as with most viral illnesses, be better in a few days to a week.

Why Can't Viral Infections Be Treated With Antibiotics?

Most viral respiratory illnesses do not need special medication and are “self-limiting”, meaning the patient’s own immune system can fight off the virus over time.

Symptoms can be treated to help you feel better, however. A patient with a viral illness should rest, drink plenty of fluids and treat symptoms with over-the-counter (OTC) medications as directed by their doctor.

Sometimes, in extended viral illnesses, bacteria may invade and lead to a “secondary infection." If a fever occurs, or the illness worsens over several days, a health care provider should be contacted.

How Do Bacteria Become Resistant to Antibiotics?

The mechanism of bacterial resistance may happen in several ways:

Bacteria can neutralize the antibiotic before it has an effect

Bacteria may be able to "pump" the antibiotic out of the cell

Bacteria could change the site of action (or receptor) where the antibiotic normally works

Bacteria can mutate and transfer genetic material to other bacteria.

Common antibiotic-resistant bacteria include Staphylococcus aureus (serious skin infections) and Mycobacterium tuberculosis (tuberculosis of the lungs). Resistant bacteria can spread from human-to-human in healthcare facilities and throughout the community.

In addition, livestock and crops can contribute to the speading of bacterial resistance. Animals who receive antibiotics can develop drug-resistant bacteria, too. These same resistant bacteria can transfer to crops via fertilizer or water contaminated with animal feces, and the crops, which the human then eats, contain the resistant bacteria. The resistant bacteria can stay in the human gut and be spread in the community. Salmonella and Campylobacter are the primary organisms becoming resistant in animals that can transfer to humans.

Can Antibiotic Resistance Affect Children?

Yes. In fact, a study published in BMJ looked at resistance in children with urinary tract infections (UTIs). Researchers found that common UTI bacteria like E. coli were now resistant to affordable antibiotics used in both industrialized and developing nations. This concern is especially high because E. coli-driven UTIs are one of the most common forms of pediatric bacterial infections.

Across industrialized nations, 53% of the pediatric UTI cases were found to be resistant to the commonly prescribed amoxicillin, 25% to trimethoprim (used alone and also found in Bactrim), and over 8% were resistant to the antibiotic amoxicillin-clavulanate (Augmentin).

Resistance was higher in developing nations. Close to 80% of childhood UTI cases in poorer countries were resistant to amoxicillin, and 60% were resistant to amoxicillin-clavulanate (Augmentin). More than a quarter were resistant to ciprofloxacin (Cipro), and 17 percent to nitrofurantoin (Macrobid).

Overprescribing in the developed countries, and availability of antibiotics over-the-counter (OTC) in poorer countries also may be to blame for the higher resistance rates.

What Can We Do to Help Stop the Spread of Antibiotic Resistance?

In an illness where the infection is due to a virus, such as a cough, cold or the flu, patients should avoid asking or demanding that their health care provider prescribe an antibiotic. The antibiotic will not cure the viral infection, and the patient may have side effects from the unnecessary medication. Most doctors are well aware of this issue, and will not give an antibiotic prescription just because a patient requests it.

For many viral infections, it may take 7 to 10 days to start feeling better. Be patient, rest, and drinks lots of fluids. Stay home from work or school if you have a fever. Over-the-counter cough, cold and pain relievers can be used to lessen symptoms; ask your pharmacist or doctor for advice.

Antibiotics that are medically important to treating infections in humans should only be used in food-producing animals under the oversight of a qualified veterinarian and only to manage and treat infectious disease, not to promote animal growth.

Should I Always Finish My Antibiotics?

The simple answer is yes.

You should finish your antibiotic regimen unless your doctor tells you otherwise. If you do have leftover antibiotics from a previous illness, do not reuse them without instructions from your doctor. And do not share antibiotics with others.

All of these scenarios can worsen antibiotic resistance, and possibily worsen your illness.

Can I Share My Antibiotics With Someone Else?

Do not use antibiotics that were prescribed for someone else, and don't share your antibiotics with others.

Even what seems like a similar bacterial illness, such as a respiratory infection, can be caused by a different bacterial strain and require a different antibiotic. Antibiotics are not a "one-size fits all" solution.

Safety is an issue too: someone you share medication with may be unknowingly allergic to it, and have a serious allergic reaction. There could be a drug interaction, too, with a medication that the person takes. Plus they wouldn't have a full course of antibiotic, if needed, to treat their infection. It's not worth it to put a friend at risk.

Antibiotic resistant bacteria can lead to a worsened infection and also spread to others if the infection is not treated correctly. Finishing the full course of antibiotic is important to help prevent resistance and to keep the infection from recurring.

My Antibiotic is Too Expensive - What Can I Do?

Many antibiotics can be expensive. If cost prevents you from buying your antibiotic it is important to tell your healthcare provider your concerns so that an alternative, lower-cost medication can be ordered.

A generic medicine, if available, are usually much more affordable and will treat the infection just as well as the more expensive brand name drug. There may be a prescription assistance program your healthcare provider can suggest, too. Online coupons can help, too. Be sure to ask your pharmacist for the best way to save money on your prescription.

What is Being Done About the Future of Antibiotic Resistance?

The US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) have launched initiatives to help address antibiotic resistance. The FDA has issued drug labeling regulations and recommends judicious prescribing of antibiotics by health care providers.

The FDA is also encouraging new and ongoing research into effective antibiotic regimens, vaccines and diagnostic tests. However, antibiotic resistance is a global epidemic that everyone -- health care providers, patients and caregivers -- can help to prevent.

Do not share antibiotics with others or use someone else's antibiotics. Plus, do not take an antibiotic left over from a previous infection.

Understand that antibiotics do not treat viral infections, like cough, colds or the flu, and do not demand that your doctor write a prescription for an antibiotic when they determine that one is not needed.

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Centers for Disease Control and Prevention (CDC). Get Smart: Know When Antibiotics Work. About Antibiotic Use and Resistance. Updated May 29, 2018. Accessed August 15, 2018 at https://www.cdc.gov/getsmart/community/about/index.html#e